Why does a Diabetic face sex problems?

Dr KK Pandey *

Diabetes although well-known to affect almost all the important organs of a human body like kidney, heart, brain, eyes, hand and feet, is also known for not sparing organs related to sex. Almost all diabetic patients quite often directly or indirectly complain of a bit decreased sex performance. Some diabetic patients due to inhibition or hesitation do not discuss sex-related problems with any body.

On the contrary, a few diabetics try to overlook this decreased sex performance and think that it is quite natural with an advancing age. In our country, the number of people afflicted with sex-related problems is around 20 million, out of them 5 million are above the age of 40. In about one million people, diabetes has a definite role in causing sex-related problems.

It is true by and large the average age of a diabetic patient is around fifty years but one should understand an advancing age never creates hindrance in enjoying sex. but in a diabetic if proper care is not taken, sex performance can be affected. Some diabetic patients never frankly admit their under performance of sex but on the top of it, to camouflage this problem, they slowly start taking course to spirituality.

It is quite true at the age of 50, the inclination towards sex and capability cannot be compared with that of a youth. but at the same time, a middle-aged person enjoys more sex in comparison to a young man, because on one hand at the age of fifty the responsibility of children and other family commitments are almost over and on the other they at that age have completely stabilized themselves in their office work and other means of livelihood.

Therefore at this age of fifty, they are less stressed-out and thus can fully enjoy the sex without any inhibition. One more advantage of this advanced age, is there is neither any performance anxiety and tension of that sort, nor any inferiority complex and depression usually related to so-called under performance.

Diabetic females too suffer

People have a misconception that, ladies suffering from diabetes do not have sex-related problems at all either in performance or in conduction. This notion has no scientific basis. A diabetic female has to face important major problems related to sex.

Firstly they suffer from excessive dryness of their sex organs due to significant drop in secretion of lubricating glands. Secondly, they lack excitement and stimulation for sex and therefore they fail to enjoy sex completely. Thirdly, a diabetic lady fails to achieve orgasm during sex. If we sum up the whole sex-related problems in a diabetic female, it can be said, the disease of diabetes disturbs all the three components of sex that is stimulation, performance and lastly achievement of orgasm.

When to consult a doctor?

People must realize occasional episodes of under performance or inability to perform should not be given much credence, because it is quite natural to have such occurrences now and then especially in unfavourable conditions and environment. These days, heavy work load and busy work schedule in office, rivalry with colleagues at work place and other mental stress, do play a vital role in jeopardizing one's sex performance.

People by and large ignore all these important reasons and wrongly believe there is some defect in their sex organs. This highly misplaced thinking gives rise to an inferiority complex and feeling of withdrawal in an otherwise normal person. This wrong notion about sex forces them to visit medical quacks masquerading as sex therapists, experts of "khandani Shafakhana" and crooks proclaiming quick results of their unique sex therapy in road side hoardings and then after that starts never ending cycle of wastage of precious money and time.

You should consult a doctor only when you have failed to achieve proper erection for the last three months. One should not mistake improper erection for premature ejaculation. One must understand very clearly that premature ejaculation is not impotence. Sometimes after surgery on prostate gland, conditions do develop wherein semen after intercourse instead of coming out, in fact goes backward into the bladder. This condition in medical terms is called a 'dry intercourse' which should not be considered at all an impotence.

Blood supply has a vital role in sex

The feeling of sex originates inside the brain. The sexually stimulated brain begins sending sexy signals to sex related organs. On receiving special signals, the blood pipes supplying pure blood to penis become dilated. With the result speed of blood flow to penis increases and here start hardening and erection of sex organ.

When due to excessive pressure generated inside the penis, all exits for accumulated blood to go out are dosed temporarily; the penis at this stage achieves maximum excitement and erection and is ready for a successful intercourse. After intercourse, all exits of veins are opened up and thus accumulated blood goes out, and then back to main veins.

Why sex performance decreases in diabetics?

Availability of nitrous oxide and oxygen is very essential to achieve a penile erection and make it fit for intercourse. At the same time a hormone called 'testosterone' found in males has a significant role in intercourse. If the supply of pure and oxygenated blood decreases, the lack of oxygen will rob the sexual performance of the penis.

In diabetics, fat and calcium continue to deposit in the walls of blood pipes and when there occurs an excessive deposit, the blood pipes get narrowed and constricted. This leads to a severe hindrance in supply of pure blood to penis whose erection then gets affected.

You would have observed that diabetics often complain of backache. This backache is due to narrowing or blockade of blood pipes supplying pure blood to organs and muscles situated in groin and lower part of abdomen. A diabetic patient often complains of backache as well as decreased sex performance. This condition in medical terms is called 'Leriche Syndrome'. The second reason of low performance on sexual front is the low blood level of a hormone called 'Testosterone'.

Quite often diabetics more or less suffer from thyroid gland dysfunctions. The low level of thyroid hormone in blood affects sex performance adversely. Generally, majority of diabetics do have blood pressure problems and the medicines to control blood pressure like Envas, Cardace, Ramace etc. may partly affect the conduction of a successful sexual act.

A wrong life-style affects sex performance

Excessive smoking and coffee intake in excess amount affect sex performance. Especially in diabetics, excessive smoking becomes a strong reason for unsuccessful intercourse. A few medicines prescribed in psychiatric illness also affect erectile function of penis.

In diabetics suffering from mental tension, the muscles inside the penis get constricted due to an invisible fear and anxiety. This results into failure to achieve a normal excitement and erection because blood in such a situation fails to find enough space for filling. Always remember- Excess intake of alcohol disturbs the sexual performance.

How to maintain and preserve sex ability in diabetics?

1. Daily morning walk for at least 5-6 kilometres.
2. Do those yogic exercises daily which increase the strength of muscle of groin and abdomen. For example Kapal Bhati, Band and Sarvang Aasan.
3. Daily cycling and swimming improve sexual performance.
4. Never allow blood sugar to go beyond control. Always consult a physician or a diabetic specialist for better sugar management.
5. Never allow your lipid profile or cholesterol level in blood to go high. Uncontrolled blood sugar and cholesterol level adversely affect sexual performance in diabetics.
6. Always/daily eat green vegetables, salad and less sweet fruits. Almonds (7-8), Khajoor, Akhrot or Chhuara should be eaten daily.
7. Avoid eating red meat (Beef, Mutton).
8. Avoid mental tension and depressive feeling at all cost. Take out times for romance with your partner. A regular disciplined life and good eating schedule go a long way in halting any deterioration in sex performance. Watching romantic and sensuous movies helps.
9. Never smoke. Tobacco-chewing and excess smoking lower sex ability and cause low sperm count and impotence.
10. Control your weight and avoid excess alcohol intake.

What a diabetic should do about his sex problem?

If any diabetic patient feels any kind of deterioration in his sexual performance, he should consult a vascular surgeon. One should not waste time and money as well in visiting various unwarranted places. As you know, the disease of diabetes affects the normal system of penis in two ways.

Firstly, it blocks the blood pipe supplying blood to penis and secondly it slackens the muscles of penis and sex organs caused by diabetic neuropathy. It is because of these 'reasons, some important relevant investigations are required.

Doppler study helps in assessment of P.B.I. (Penile Brachial Index). If PBI is less than 0.6, it means the blood supply to penis is reduced. Some special investigations like estimation of prolactin, testosterone, sugar and PSA in blood are essential.

Assessment and grading of hardness of penis is also done by injecting a special drug called PGE-I. If after injecting PGE-l, one gets the desired erection and hardness, it means blood supply is manageable and working of muscles and veins of penis is within acceptable limits.

If blood supply to penis is below average, ways and methods are explored to restore the blood supply. Some special investigations like DICC (Dynamic Infusion Cavernosomety) and 64-Slice CT pudendal angiography are required. For assessment of neuropathy, PEP (Pudendal Evoked Potential) and bulbo cavernosus reflex time may be required.

Treatment Modality

In about 90% cases of diabetics suffering from decreased sexual performance, no surgery is required. Such patients can significantly restore their sexual prowess simply by improving their diet, modification in their life style, avoiding of narcotics and by doing some specific exercises.

Sometimes medicines like sildenafil, verdanfil may help but these medicines should not be taken without the advice of a doctor, because carelessness may do more harm than doing any good. In some special circumstances, injectable preparations are used. In a few cases a medicine like alprostadil may be given through the urinary passage (Urethra).

Exercise utmost care in use of medicines like Viagra

Elderly people should take only half the amount per day, that is 25 mg. Never take more than 100 mg a day, otherwise a severe drop in blood pressure may occur. Any patient who is taking sorbitrate or nitrate for his chest angina, should avoid Viagra like medicines. Those who had brain stroke or heart attack recently should never take Viagra.

Always remember Viagra like medicines should never be taken without a doctor's advice. One should also know, medicines required for AIDS treatment interacts with Viagra, so better be careful.

Prevention is better than cure

If you are a diabetic, you should take precaution from the very beginning, to prevent any sex problems from developing at a later age. Always remember, prevention of this problem in diabetics is better than its cure. In about 8-10% cases, surgery may be required wherein measures are taken to increase blood supply and to prevent venous leak.

Artificial penis or prosthetic implant should be used as a last resort when other available methods have failed. Artificial prosthetic implant has its own limitations and problems. Therefore it should not be considered as a primary method of treatment but as a last treatment when everything else has failed.

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* Dr KK Pandey wrote this article for The Sangai Express . The writer is a senior consultant in the Department of Cardiothoracic and Vascular Surgery at Indraprastha Apollo Hospital, New Delhi, and can be contacted at drpandeykk(at)gmail(dot)com .
This article was webcasted on November 07th, 2009.

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